London,[1] and has been since observed in every case of lead colic, whether impending or present.—If alarm be not taken in time, the obscure complaints hitherto mentioned become attended by and by with uneasy sensations in the stomach, stretching ere long throughout the whole belly. At the same time the stomach becomes irritable, and the food is rejected by vomiting. Cramps in the pit of the stomach then arise, and extend to the rest of the belly, till at length the complete colic paroxysm is formed. The pain is sometimes pretty constant; sometimes it ceases at intervals altogether; but much more commonly there are remissions rather than intermissions; and it is remarked that both the remissions and exacerbations are much longer than those of common colic. The pain is very generally, yet not invariably, relieved by pressure; even strong pressure seldom causes any uneasiness, provided it be not made on the epigastrium; nay, some patients have been known to bear, with relief to the paroxysms, the weight of two or three people standing on the belly.[2] The belly is almost always hard, the abdominal muscles being contracted: sometimes it is rather full, more commonly the reverse, and the navel is often drawn in so as almost to touch the spine. The bowels all the while are obstinately costive. Either there is no discharge from them at all; or scanty, knotty fæces are passed with much straining and pain. This state, long supposed to depend on spasm, is now known to arise on the contrary from paralysis, of the intestinal muscular coat. In a few instances diarrhœa takes the place of the opposite affection. The urine is commonly diminished. The saliva has been described as greater than natural in quantity and bluish in colour; but Dr. Burton says he did not observe a single instance of this in forty cases which he carefully examined. From the beginning, or more generally after a few hours or days, the limbs are racked with diffuse cutting pains; which, according to Tanquerel, affect chiefly the limbs, especially near the joints, are worst at night, are often attended with cramps, and are relieved by pressure. The aspect of the countenance is dull, anxious, and gloomy: in advanced cases the expression of gloomy anxiety exceeds that of almost all other diseases. It appears from the latest works on this disease published in France, and particularly from the able treatise of Mérat, that the pulse is rarely accelerated, but on the contrary often retarded.[3] This does not accord with the experience of some earlier writers;[4] and in the few cases I have seen in this city the pulse has been always frequent. It cannot be questioned, however, that, as Mérat states, fever is not essential. The skin has a dull, dirty, cadaverous appearance, is often, though not always hot, and in either case is bedewed with irregular, clammy, cold perspiration.
This, the first stage of colica pictonum, may end in three ways. In the first place, the patient may recover at once from it as from an
